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Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The renal artery is accessed via a common femoral artery puncture and is selectively catheterised using a catheter such as a renal double curve (RDC) or Cobra. If the purpose of the procedure is embolisation, then a catheter without side holes must be selected to prevent non-target embolisation. A pigtail catheter may be positioned at or just above the origin of the renal arteries and used with an injector pump to visualise both arteries simultaneously (see Fig. 7.13b). Selective imaging of the renal arteries is performed using a RDC or Cobra catheter at the renal artery origin. An angle of 10° LAO for left kidney and 10° RAO for right kidney may also improve visualisation. For transplant kidneys, review of the cross-sectional imaging will be necessary to determine the best access route, the most appropriate catheter shape and the optimal C-arm angulation for visualising the renal artery origin. Buscopan may be helpful to reduce movement artefact from overlying bowel.
Throat
Published in Marie Lyons, Arvind Singh, Your First ENT Job, 2018
The history is of swallowing a large lump of food (it often seems to be steak!) which then gets stuck. The patient often has absolute dysphagia and is spitting out their own saliva. Take a careful history and really press the patient on whether there might be a bone present in the bolus. Enquire about previous symptoms of dysphagia, heartburn, weight loss, etc., and obtain a lateral soft-tissue neck X-ray just in case. Give the patient 20 mg intravenous Buscopan (a muscle relaxant). This can be repeated after 30 minutes if necessary and then three times a day. You can also try to give them a fizzy drink. If the patient does not recover quickly after the Buscopan (it sometimes works like magic!), admit them for intravenous fluids. If the patient has not settled by the next morning they will need an endoscopy and removal of the bolus. If the patient settles after the Buscopan and can prove to you that they can drink a glass of water, they can be discharged with advice on eating a soft diet for a short while. In any case, every patient must have a barium swallow arranged and be followed up in clinic, as they may have a stricture or early malignancy which contributed to the obstruction in the first instance. If the obstruction seems to be low in the chest (and some patients can feel this pretty accurately), we often refer them to gastroenterology for a flexible gastroscopy. Foreign bodies that are low down in the oesophagus can be more difficult and hazardous to remove by rigid endoscope than by flexible scope.
Managing the adverse effects of analgesics
Published in Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley, Symptom Relief in Palliative Care, 2018
Mervyn Dean, Juan-Diego Harris, Claud Regnard, Jo Hockley
Antispasmodics: Hyoscine butylbromide (Buscopan) (Canada only) usually has few adverse effects, but hyoscine hydrobromide (known as scopolamine in the US) can cause marked central anti-muscarinic effects. In the US use hyoscyamine (Levsin) 0.125–0.25 mg PO/SL tid-qid PRN.
Implications of colonic and extra-colonic findings on CT colonography in FIT positive patients in the Dutch bowel cancer screening program
Published in Scandinavian Journal of Gastroenterology, 2021
Marieke H. A. Lammertink, Jelle F. Huisman, Marie L. E. Bernsen, Ronald A. M. Niekel, Henderik L. van Westreenen, Wouter H. de Vos tot Nederveen Cappel, Bernhard W. M. Spanier
All CTCs were reviewed by specialized CT radiologists whose experience ranges between 3 and 25 years of working with virtual colonoscopy images. All worked with Philips IntelliSpace Portal with CT-colonography software and computer-aided detection (CAD) and used 3D viewing, or ‘filet-view’, utilizing 2D views in case of relative doubt. Patients were scanned in prone and supine positions. Automatic exposure control was used in all patients. Tube voltage during scanning was 130 kV. Milliamperage values were adjusted according to contrast agent administration and patient size (around 50–95 mAs). Bowel preparation was accomplished by means of a low-residue diet and cathartic cleansing with oral administration of sodium ioxitalamate (Telebrix® Gastro) starting 24 h prior to CTC examination. Spasmolytics (Buscopan®) were administered to reduce insufflation-related discomfort and facilitate bowel evaluation. The reporting of extra-colonic findings was performed routinely.
The value of a first MRI and targeted biopsies after several years of active surveillance for low-risk prostate cancer – results from the SAMS trial
Published in Scandinavian Journal of Urology, 2020
Stefan Carlsson, Ola Bratt, Dushanka Kristiansson, Fredrik Jäderling
MRI was performed at three different sites using a bi-parametric protocol including T2-weighted imaging in three orthogonal planes (sagittal, axial and coronal), axial T1-weighted covering the small pelvis and diffusion-weighted imaging (DWI), with a calculated high b-value and an ADC-map 16 patients were scanned on a Magnetom Aera 1,5 T (Siemens Medical Systems, Erlangen, Germany), eight patients on a Magnetom Verio 3 T (Siemens Medical Systems, Erlangen, Germany) and 21 patients on an Achieva 3 T, (Philips, Einthoven, Holland). The MRI protocol is briefly described in Supplement 1. The participants were asked no to ejaculate the 3 days before the examination. On the day of the MRI, they were recommended to use a small enema approximately 2 h before the examination. Just before scanning, an intramuscular injection of either 20 mg of Buscopan or 1 mg Glucagone was given.
Computed Tomography Colonography Versus Standard Optical Colonoscopy for the Detection of Colorectal Polyp in Patients Who Faced Curative Surgery for Colorectal Cancer: A Diagnostic Performance Study
Published in Cancer Investigation, 2020
Computed tomography colonography of patients was performed using Revolution™ Computed Tomography (GE Healthcare, Waukesha, WI, USA) and Dual-energy Computed Tomography (Siemens Healthineers, Cary, NC, USA) equipment on supine and prone position with single-breath-hold protocol. Revolution™ Computed Tomography scanning protocols were as follows: tube voltage of 70 kVp, reduced noise levels with Integrated ASiR-VTM technology, scan up to 200 cm and 675 lbs, 16 cm of detector coverage, 80 cm wide bore, 160 mm axial acquisition, 2× reconstruction, 0.23 mm imaging, 437 mm/sec scanning speed, 0.25 msec ultrafast switching, and 50 cm field of view. Dual-energy Computed Tomography scanning protocols were as follows: tube voltage of 120 kVp, tube current of 50 mAs, and section thickness ≤1.0 mm. Patients were positioned in the left decubitus condition for insertion of a thin flexible rectal tube before colorectal insufflation. Intravenous hyoscine (Buscopan, Sanofi-Aventis Ltd., Reading, Berkshire, UK) was administered to patients. Insufflation was done mechanically with an automated CO2 insufflator (HP-2, Horii Pharmaceutical, Osaka, Japan). Polyps were analyzed according to localization, size, and morphology. Further analysis was performed for 5 cm of the surgical anastomosis region. Computed tomography colonography was performed by three radiologists (unaware of any clinical information, a minimum of 3 years of experience) of the institutes.